I wrote this post in support of my friend, and guest host this week, Catalina Egan. Catalina's 'Peace Blitz'blog tour focuses on peace, and on an event, that possibly impacted world peace, that she explores in her book, The Bridge of Deaths. Please, take the tour today, read more about her book, and the thought-provoking posts of some of the tour participants. I pray you will take in the message that peace begins with you.

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Tuesday, August 7, 2012

"Finish up, Jane." It was ten till five. Jane was my last patient of the day. Our half-hour session had already stretched to fifty minutes, mostly consisting of me, wheedling, and her, whining. Getting her to workout was like pulling teeth. The only exercise she liked was jawing. I stifled a yawn, nostrils flaring, breathing in the smell of brewing coffee: nectar of the gods. Like Pavlov's dog, my mouth watered. I stood, stretched out a kink in my back and stepped out in the hall. The Nurse's station was abandoned. It was so quiet I could hear the gurgling sound as the last drop of coffee dripped down in the pot. The nurses were all in the break-room...with their coffee. It was shift-change. Nurses coming on were taking report of patient's status from the nurses getting ready to go home. I longed to walk down and join them for a nice cup of java; wanting to be just about anywhere else then stuck here with Jane. I sighed, glancing back at her. Jane Mathews, my blue-haired, pink-curlured, hip-replacement-patient-from-Hell, sat, pouting in her wheelchair, dilly-dallying. "This one is stupid." Jane pointed a pudgy finger at the instruction sheet I'd given her. "Gotta do it, Jane, Doctor's orders." I crossed my arms, waiting. Jane was not one to pass on the opportunity to argue…she thrived on it. If a study was ever conducted on how to burn calories flapping your gums…I’d sign her up. Her chin jutted forward. “He’s an idiot.” She tossed the instructions aside, a gleam in her eye, gauging my reaction. Dr. Larkin was an idiot for letting her bully him into staying on the unit. No one, including him, wanted to put up with her, but census was low. We needed patients on the unit or staff would be dismissed. Keeping her was the lesser of two evils. Her lack of appreciation was irritating. “That idiot extended your length of stay. Remember?” I pasted a smile on my face. “You were supposed to go home last Wednesday.” “Don’t act like he walks on water, Linda,” she snorted. “He’d have booted me out in a heartbeat if I hadn’t told my insurance company on him.“ That ticked me off. She was milking the system and we both knew it. “Most hip replacement patients are home in four days, Jane. You’ve been here a week.” Every second of which was indelibly etched on my consciousness. Every bitchy comment she made, all the times I had to argue to get her to comply with any basic instruction…spoke of her manipulative nature. I couldn’t wait to be rid of her. “So, what? That paper I signed when I came here said I wouldn’t leave until I’m ready.” She snatched her exercise sheet up, mouth open, squinting over her bifocals to read it. “And I’m not ready!” “Just finish your exercises, all right?” Lord, the woman was going to drive me crazy. Jane snatched a piece of yellow thera-band off the mat, looped it under her foot and started circling her ankles. I turned at the sound of the elevator opening, sighing when Jane’s friend, Millie, stepped out. Crap! Now, I'll never get Jane out of the gym. "Hi, Linda," Millie said, smiling her sweet smile, walking slowly towards me, listing side to side like a ship rocking on waves. A purse the size of a carry-on dangled from her shoulder, bouncing against her hip. It looked heavy. Her knees rubbed together, making a whooshing sound, with each little step. "Hello, Millie." I cringed at the grinding sound of crepitus in her joints as she passed. “You’ve got to get those knees done before they give out, girl. You should talk to Dr. Larkin.” “I know, dear.” Millie waddled through the gym door, breathing heavily. “Leave her alone, Linda.” Jane gave me a knowing look. “He’s not cutting up my friend just to get patients in this place.” Lord, help me. I counted to ten… lips stretched over my teeth in a smiling grimace. I wonder if my hands can stretch around Jane’s flabby neck. Dismissing the thought, I walked to the cabinet, got the spray sanitizer and a couple of towels off the linen cart…anything to keep my hands busy. Jane forgot all about me…and her exercises. The floodgates opened. She spewed all the latest gossip, eyes gleaming, waddle wiggling in time with her acid tongue. Millie was getting the dirt...all the dirt...and nothing but the dirt, whether she wanted it or not. I sprayed the empty mats, wiped them off, than polished the fingerprints and grime from the parallel bars. Environmental Services has cut back so much that the gym hasn’t had a good cleaning for a couple of weeks. Back in PT school they never told me I’d be doing an aide’s work as well as my own, I thought, swiping up a dust bunny that floated out from under the mat. Jane’s voice buzzed in the background like a gnat at my ear. From the corner of my eye, I saw her toss a two-pound weight on the mat I’d just cleaned. I picked it up, cleaned it and stuck it in the weight-rack. Clearing my throat, I looked at my watch, and pointed at her exercise program. “Finish up, Jane. It’s late.” "I have a visitor! I'm allowed to talk to my visitor if I want to." Jane laboriously leaned her massive bulk left, staring hard at me as she clenched, then released, her butt: making her head bob up and down with each repetition of, what she called, her 'butt crunches'. It was amazing she could lift her butt at all, considering she deserved a special dictionary entry under corpulent …a subheading, entitled ‘lard-ass’. "Are you happy now? I'm going to tell Dr. Larkin about you. Don't think I'm not," Jane said. How does someone become so hateful? Every ounce of the Irish in me wanted to vent. I felt my left eyebrow quirk and took a deep, calming, breath. Remember...first, do no harm: that was the oath I took when I became a physical therapist. Her threats didn't worry me. She could complain to Dr. Larkin all she wanted. Fat lot of good it would do her. He knew what she was like. (He called her the Grey Gorgon in private.) She bullied everyone and couldn't find a nice thing to say to, or about, anyone. "Jane! That's uncalled for." Millie's tone was uncharacteristically sharp. The long walk from the parking garage had taken its toll on her. She stood, leaning against the wall, breathing heavily. "Don't mind her spite, Linda," Millie said, lips pinched and drawn as she sucked air in and out in a wheezing whistle. "Are you all right, Millie?" I eyed the oxygen valve on the wall, relieved to see a bag of tubing hanging there, ready, in case of emergency. I opened the cabinet, reassuring myself that the pulse-ox was there. Respiratory Therapy was so short-staffed that it paid to double-check. "I'm fine." Millie shifted her weight. "Just a little tired, that's all." No wonder. Jane could suck the life out of a twenty year old and Millie hadn't seen twenty in years. I brought her a chair. "Why don't you sit down and put your feet up until Jane finishes. She won't be long." I looked pointedly at Jane. "What are you, the exercise Nazi?" The stodgy framework of Jane’s jaw stood out stubbornly beneath her jowls. Please, Lord, give me patience. He did. I took the high road and ignored her. "Mind your tongue, Jane." Millie sighed heavily as she sat down. “Thank you, Linda. I haven't been myself at all today." She patted her chest. "I'm plumb out of steam." Perspiration dotted her upper lip. "It's hot outside. Would you like a soda, Millie? Or, some ice water?" I had a soft spot for her. Why she put up with Jane was beyond me. "No, thank you." Millie crossed her swollen ankles and clasped her hands, resting them on her ample stomach. "I'm better now. Don't fuss about me." Jane looked askance at Millie over the top of the sheet of exercises she was pretending to perform. "You wouldn't be so winded if you'd lose ten ...or fifty pounds." "Talk about the pot calling the kettle black!" Millie crossed her arms over her potbelly. "Oh, be quiet!" Jane frowned at her than turned her venom on me. "What about my wheelchair cushion? I told you this one isn't comfortable." She leaned, tugging hard on a piece of the leather cushion squished flat beneath her. She wrinkled her nose, holding up a piece of the leather she'd just torn off. "Look at that. It's falling apart. This piece of crap better not show up on my bill!" She pushed her bifocals back, the better to glare at me. I refrained from rolling my eyes. "The cushion will be in tomorrow, Jane." Like I told you ten times already, I thought. I sat down at my desk, tuned her out, and worked on finishing my charting. I'd kill for a cup of coffee about now. Jane whispered something behind me, hushing abruptly when one of the Candy-Stripers stopped in to deliver her mail. "Hello, dear," Jane smiled at the girl as she opened her letter, "my, don't you look pretty today." As soon as the she was out of ear-shot, she leaned in to Millie. "I bet she's knocked up. Did you see that panty line? Thong!" She clenched her butt. "That's a slut-slingshot for sure!" Millie darted a look at me, blushing to the roots of her white hair. Poor, Millie. Jane is an albatross hanging around her neck; making her guilty by association. I smiled, absolving her of complicity, and checked the clock for the hundredth time. "You finished your leg raises, Jane," I said, my lips stretched so tight it hurt me to smile. "Fifteen knee extensions and you're good to go." "Don't hurry me!" Jane frowned, looking like she was preparing to say more. She is working my last nerve. It will be worth the endless sessions I'll have to undergo with HR, just to tell her what I think. I crossed my arms, preparing to let her have it. Millie must have sensed I'd had enough. "Hurry up, Jane," she said, smiling at me, her face flushed. "We have to get to your room in time to turn in your dinner order." She rocked back and forth a few times, struggling to stand up, heaved herself out of the chair than moved to sit on the mat. "Here," she took the exercise sheet from Jane," you've done all but this one." She kicked her leg out to demonstrate. "Not worth the bother." Jane kicked her dimply leg out, paused and lowered it down, clucking like an old hen. "The kitchen help should be fired...the food's not fit for a dog." Yet, you always order two trays, I thought, trying to write something resembling a professional note to justify her stay on the unit. The truth —doesn't need rehab, needs a kick in the butt— would not get it. "You should see my bathroom, Millie. It's a mess! “Jane stopped suddenly, right leg extended straight out in front of her. "Are there coloreds on this floor?" "What?" Millie and I spoke in unison. I put down my pen, unable to believe what I'd just heard. Jane pointed at Nurse Edward's back when she passed by. "I hope she's not my nurse tonight!" She cupped her hand over her mouth and whispered, "She's a darkie." Millie’s face was crimson. I stared at Jane a moment, not trusting myself to speak. “What?" Jane shrugged, clueless. In her world everyone was a racist. "You would be lucky to have her," I said, my words clipped and terse. Jane snorted, "She's not touching me!" I felt the heat as my face flushed. "That's enough for today." I snapped the chart shut. "I'm not finished," Jane said, waving her exercise sheet at me. "We'll start out tomorrow where you left off. It's time to go." I opened the storage closet and started gathering up the walkers, canes and loose equipment: anything to keep my hands away from Jane. "Fine!" Jane yanked the brakes off her wheel chair and maneuvered away from the mat. "Come on, Millie." I bent down to get a tissue off the closet floor. "Millie! Oh, my God! Linda, help her!" "What is it?" I tripped over a crutch, hurrying to get out of the closet. Jane was blocking my way, pointing at the mat. “Help her!” I could just see Millie. She had collapsed back on the mat. “Get out of the way, Jane.” I pushed her wheelchair far enough away to squeeze by and ran to Millie. Her head was to the side, eyes open, drool oozing from the side of her mouth. I screamed for help and hit the code alarm button on the gym wall to alert the nurses to come STAT as I went into that, auto-pilot, state all clinicians enter when confronted with a possible 'code'. I checked Millie's pulse, respiration: none. "Go to the nurse's station and get help, Jane!" I yelled: palms sweating as I checked Millie's airway: clear. Fighting panic, I straddled her stomach and initiated CPR, praying to God she'd live. "And one, and two and three and four,” I counted my compressions, feeling her sternum press back against each deep thrust. Where are the nurses? The Code Team should be here by now. I tilted Millie’s head, pressed my lips against hers and gave two slow steady breaths, watching her chest wall rise with each. Please, God...please, God. Where are the nurses? My heart pounded in my throat. "You're losing her!" Jane rammed her wheelchair into my foot, trying to get close to Millie. She threatened the control I desperately needed...clung to... I couldn't take it. "Get your ass to the nurse's station, now!" I screamed at her, tears rolling down my cheeks as I resumed compressions. Frightened into action, Jane wheeled herself out in the hall and screamed for help. Millie was cold, ashen…her gaze: fixed. I checked again for a pulse and couldn't find one anywhere. "Oh, my God...Oh, my God," I sobbed, continuing compressions I knew were probably worthless. Finally, I heard the pounding of feet against the tile, heard shouts as the Code Team arrived with the crash cart. Tears blinded me. I couldn't see who touched my shoulder and moved me aside. "Get her out of here!" A doctor pointed at Jane. A nurse wheeled Jane away and shut the door, closing us in. I stood staring, watching as they tried the defibrillator. I knew it was too late. "Call it," one of the Docs said, checking his watch. "She's gone." She's gone. Gone. Just like that. Gone. I felt so strange standing there, my arms wrapped tight about myself, watching them cover her with a sheet, gather their equipment...putting each item back on the cart...all tidy now. "This is just terrible." Nurse Edwards’ voice sounded far away as she rubbed my back. "Are you all right, Linda?" "You did all you could do," the Doc glanced at my badge," Miss Smith." He patted my arm. "She was a heart attack waiting to happen." No, she was Millie, and now, she's dead. Soon they'd take her down to that cold basement room where she'd lay, bundled like a cocoon, waiting to be taken to the morgue. Bile churned in my stomach. I felt like vomiting. Nurse Edwards took my hand. "Come with me," she said. She put her arm around me and walked me to the nurse's station. "Sit down, Linda, you've had a shock." She pulled up a chair and sat down beside me, waving at an aide in the hallway. "Brenda, get her a glass of water...and get a blanket from the warmer." I felt her hand stroking my back. "It will be all right, Linda." After I calmed down a bit, she pulled out the Procedure's binder and handed me the Incident Report form, taking one for her-self. "Better get it over with while it's fresh in our minds," she said, sighing heavily. I stared at the form awhile, the scene replaying itself, over and over, in my head. The sick nervous feeling in my stomach got worse. I needed to pinch myself and wake up. I put my cup down, my hands shaking so much I almost knocked it over. "Why didn't you come quicker?" I asked, not realizing I'd spoken aloud. "The defibrillator might have saved her." Nancy Edwards looked up. "What?" She tapped the pen on the paper. "I wasn't going to say anything about that...but, you should have sounded the alarm. If Jane hadn't screamed..." "I did hit the alarm! Ask Jane. She saw me." My head pounded. "Didn't you hear it?" "Well, it didn't go off." We looked at each other. Several repair requests for that alarm had been submitted over the last two months but Administration put it off. They were nickel- and-diming us to death. Every available dollar was allocated to construction of the new hospital; meanwhile Clinton Memorial was left to die a slow death. We did our best with barebones staff, short on supplies. "Maintenance was supposed to fix it." Nancy clicked her pen as the ramifications of a faulty alarm sank in. Click...click...click. "This one's going to have to be flagged for review now. Great," she said, sighing as she started filling in the blanks that must be made to say that nothing untoward had occurred...that this was a 'good' code. I was so angry I couldn't sit still. "I can't do this right now." I stood up and walked out, blood pulsing through my veins so hard I could feel the ridges of the vessels at my temples when I rubbed them. I just wanted to go home and cry...take a bath and try to scrub myself clean. She shouldn't have died. She shouldn't have died. I was down the hall, leaning my head against the wall, waiting, listening for the sound of the elevator in the shaft, when I thought of Jane. Crap! I couldn't, in good conscience, leave without checking on her. I turned and walked back down the corridor, feeling like I was in Hell. I knocked on the door of room 3204. I could hear Jane, crying inside: loud, gulping sobs. I stepped in to the darkened room. "Jane, are you all right?" She was lying with her back to the door, looking out the window. I made myself walk over to the bed "Can I call someone for you?" "There's no one to call." She put her arm over her face, her body quivering with the effort to control her tears. "There must be someone." I noticed the deck of cards on her bedside table. She and Millie were big Rummy fans. She lifted her arm, looking around for something to wipe her face. It was a swollen mess. "Here," I handed her the tissue box, "you shouldn't be alone. Tell me who I can call." She shook her head and blew her nose. "She was my only friend." "I'm so sorry, Jane." I sat down in the chair by her bed, unsure what else to say. She seemed glad of my company. "I couldn't stand Millie at first, you know. She got on my nerves," Jane said, blowing again, hard, her breath coming out in quivers. "She irritated the hell out of me, sucking up to the Pastor all the time. I’d never seen such a do-gooder in all my life." She stared out the window. “But, it wasn’t an act.” She gulped, struggling to speak. “She really loved me.” “She is…was a sweet woman,” I said. "She was a Saint. You might not believe it, but I can be hard to get along with." Her lop-sided grin made me cry. “Millie…and, John, were the only ones who could see through me,” she gulped. “Now, they’re both gone.” Jane told me how Millie stood by her when her husband, John, died of brain cancer. “He lingered almost two years…it was terrible. I couldn’t have made it without Millie. “ We sat there, talking quietly until the dinner trays arrived. I stood up, surprised at the time. "I've got to get home. Is there anything I can get you before I go?" "Can you hand me my Bible?" That struck me as odd. She certainly didn't seem the religious sort. I picked up her old rag-tag King James Bible. It felt solid and comforting in my hand. I gave it to her and turned to leave. "Will you be in tomorrow?" Her words came out in a rush. She avoided my gaze when I turned. "Yes." It dawned on me why she was so bitter. She was lonely. Now, she had no one. "I'll check on you first thing in the morning, OK?" “I don’t mind if you do…or don’t,” Jane sniffed, trying hard to sound like her old, testy, self. “Well. All right, then,” I said, “I’ll see you in the morning.” “Don’t come too early. Not before Dr. Phil. You know I don’t want to miss my show.” I raised my brows. “Fine, come when you want,” Jane said, a shaky smile quirking the right side of her mouth. Driving home from the hospital, I couldn't stop thinking of Millie's sightless eyes, Jane's grief ...and that broken alarm button. I told myself it was an unfortunate reality. Millie was a heart attack waiting to happen that 'happened' on my watch. That was all. I'll fill out the report in the morning. But, that plan just didn’t sit right. I sat in my driveway for the longest time, thinking. I saw Jane's face when I told her I'd check on her... felt the weight of her Bible in my hand. I know what I have to do. I cannot let my report be filed away where no one will ever see it. Millie...and Jane deserve better. I will fill out the report, copy it ...and those denied maintenance requests, and send the lot of it to the agencies responsible for monitoring patient safety violations. Clinton Memorial can go straight to Hell, I thought, remembering the sweetness of Millie’s smile. There are worse things than being unemployed.

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